COVID-19 Vaccination Sites: Maximizing Booking Capacity and Management Guidance Amidst the Coronavirus Pandemic

Official

Version 2 as of 20 May 2021

Publications approval reference: C1277

This document was correct when published. However, as it undergoes updates, kindly verify the information you disseminate to the public by using the hyperlinks to ensure accuracy.

Changes since v1 (7 January 2021) are highlighted in yellow.

1. Foreword

1.1. The aim of this standard operating procedure is to equip operational leads and site managers of Vaccination Sites with essential information and guidance on establishing and managing the booking capability of each site.

2. Generalities

2.1. The National Call Recall Solution is composed of:

• National Booking System (NBS)
• Call/Recall Call Centre (dispatching letters and making follow-up calls)
• Operations Centre (for telephone-assisted bookings via the 119 helpline).

2.2. NBS provides the functional features for individuals to book their appointments for COVID-19 vaccination at a vaccination site, whether online or by phone through the Operations Centre (via 119). Some PCNs also rely on NBS for the administration of vaccination appointments for cohorts 10-12.

2.3. NBS complements other existing Primary Care Network (PCN) and secondary care booking services already involved in the delivery of vaccines.

2.4. Q-Flow is the administrative application and booking software that lies behind and collaborates with NBS. The NBS (Q-Flow) website for vaccination sites offers more relevant information, as well as a user guide customized for this purpose.

2.5. Key parameters of NBS include:

• NBS handles multiple types of vaccinations
• Invites accurately match vaccination site capacity to avoid over- or under-booking

The Medicines and Healthcare products Regulatory Agency (MHRA) has licensed COVID-19 Vaccine (AstraZeneca), COVID-19 mRNA vaccine (Pfizer/BioNTech), and COVID-19 mRNA vaccine (Moderna) for a two-dose schedule. For more information, please refer to the JCVI guidance published on 30 December 2020.

The Vaccination Programme's decision is to open bookings from week 11 after the first vaccination dose and to ensure that second dose appointments are scheduled by the twelfth week after the first dose, according to JCVI guidance issued on 30 December 2020.

On 15 May 2021, in response to advice from the independent JCVI, the government updated this guidance to speed up second doses for cohorts 1-9, bringing forward appointments for the remaining individuals in these priority groups from 12 to 8 weeks. For those below 50 years of age, the first dose would be administered, and their second dose shall be scheduled at a 12-week interval, as the deployment strategy has been until now. Complete guidance is available here.

Consequently, NBS configuration for second dose intervals for AstraZeneca has been modified from 77-84 days to 56-84 days. Pfizer and Moderna's interval settings will remain fixed at 77-84 days as few people in cohorts 1-9, who would be expected to book their second dose through NBS, have received Pfizer and Moderna as a first dose. This will be updated for this group at a later stage.

JCVI guidance defines the vaccination priority groups for different phases of the COVID-19 vaccination programme. Pregnant women should be offered the Pfizer-BioNTech vaccine or Moderna vaccine, according to recent JCVI guidance, and they can now book their appointments on the NBS at a site that offers PfizerBioNTech or Moderna following a series of screening questions.

Pregnant women seeking COVID-19 vaccination must be permitted to schedule appointments for the Moderna or Pfizer BioNtech vaccine in accordance with age and clinical group guidelines. The Green Book from Public Health England has been updated accordingly, with more details available at this link.

Every pregnant woman, or anyone who suspects they may be pregnant, should have an opportunity to discuss the risks and benefits of vaccination with a healthcare professional before making an informed decision about whether to receive it. Women can do so either at their vaccination appointment or through their maternity clinic or GP office.

To book a COVID-19 vaccination through the National Booking Service (NBS), residents of England must first register with a General Practitioner. Commissioners will identify individuals without a GP, including those who are homeless or part of a travelling community.

When scheduling a vaccine appointment through the NBS, individuals must also concurrently schedule a second-dose appointment. Under current guidance, patients will receive the same vaccine for both doses.

Assuming available appointments within the 77-84 day window, the NBS will provide a selection of second-dose appointment slots at vaccination sites that support the same vaccine type as the first dose.

As of May 25th, the NHS will reach out directly to priority cohorts 1-9, who have booked their second-dose appointment via the NBS and whose appointments fall more than 8 weeks after their first dose, to urge them to pursue an earlier appointment.

Regarding invitations to book a vaccination appointment, eligible individuals will receive a text or letter with instructions for booking either online or by calling 119 (detailed in this video).

NBS verifies eligibility of candidates based on the National Immunisation System and provides access to available appointments within a 60-mile radius. Those under 40 (excluding clinically vulnerable and clinically extremely vulnerable) will be directed to Moderna or Pfizer-BioNTech vaccine appointments, per JCVI guidelines. Pregnant individuals and those who have received their first PfizerBioNTech vaccine dose will also receive second doses of PfizerBioNTech vaccines.

Anyone who received their first dose in a vaccination centre or community pharmacy will need to wait 24 hours before booking their second appointment through NBS, as their first dose vaccination will be recorded in the Point of Care System and will only appear in NBS the following day.

Individuals are able to book appointments up until midnight the day before their scheduled vaccination. It is recommended that vaccination sites create a backup list of the day's appointments at the beginning of each day in case access to Q-flow is lost.

Most people will book their appointments using the NBS. However, certain eligible individuals may not have access to or be able to use the NBS. Additionally, vaccines may be administered to minimize waste or at community pharmacy-led sites with permission from the commissioner under the terms of LES. Appointments for these patients can be added manually to the Outcomes4Health/Pinnacle Point of Care system. Patients will then be able to book their second dose appointments via the NBS within 24 hours of the record being created. For more information, refer to the SOP for COVID-19 local vaccination services deployment in community settings and the Operating Framework for Vaccination Centres.

Vaccination sites are expected to have local arrangements in place to fill appointments that are not being booked through the NBS. This may include engaging with local health and social care workers or utilizing walk-in operating models. Further guidance on outreach models is currently being developed.

Patients with NBS appointments must be checked in on the NBS system. More information can be found on the NBS (Q-Flow) website for vaccination sites, along with a user guide.

Provider set-up will be carried out by the national team for sites created from Wave 13 onwards. Site managers will be responsible for setting up site attributes and appointment availability on the NBS. They will receive login details around one week before the expected go-live date. There are step-by-step videos and training materials to assist site managers with this process.

Site managers are responsible for updating accessibility and transport information about the site they manage. Site managers should input the site's longitude and latitude details when creating the site. These coordinates will be used to calculate distance from postcodes entered into the NBS. Patients can choose a site that meets their accessibility and transport requirements.

Site managers need to set up user accounts for anyone at their sites using Q-Flow with relevant roles and permissions, including other site managers, arrival stewards, and assessment clinicians.

4.8 It is recommended that site managers deactivate the user accounts of staff who are no longer working at the vaccination site to prevent access to patient data in NBS. Detailed instructions on how to do this can be found in the ‘Edit a User’s Account’ section, accessible at https://digital.nhs.uk/coronavirus/vaccinations/q-flow-guidance/createand-manage-user-accounts

5. Appointment Capacity Management

5.1 To avoid any confusion or cancellations, site managers at Vaccination Centres must publish two weeks of appointment availability for booking one's initial vaccination appointment. This period may be adjusted regionally.

5.2 Individuals are required to book both their first and second doses when booking through NBS. For those sites administering the AstraZeneca vaccine, the appropriate second dose window should be from day 56 of the first clinic to day 84 from the last clinic. For Pfizer-BioNTech or Moderna, the second dose window should be between day 77 of the first clinic and day 84 from the last clinic. Therefore, site managers must publicize a further three weeks of appointments during the appropriate second dose window to accommodate second appointments and provide additional capacity for HSCW and walk-ins. This will provide a flexible seven-day window for individuals to book their second appointment.

5.3 Initially, site managers should not differentiate between initial and second vaccination appointments unless otherwise agreed upon regionally. Unutilized second appointments in the second dose window will eventually be filled as first appointments only once appointment capacity for second dose appointments has been scheduled.

5.4 Community Pharmacies and PCNs must publish one week of appointments for first and second doses in line with confirmed vaccine deliveries or as agreed regionally. For AstraZeneca vaccines, the appropriate second dose window should be from day 56 of the first clinic to day 84 from the last clinic. For Pfizer-BioNTech or Moderna vaccines, the second dose window should be between day 77 of the first clinic and day 84 from the last clinic.

5.5 Site managers may add more availability every week as long as vaccine supply is confirmed for the site. However, appointments should only be released if the vaccine allocation is guaranteed along with the corresponding second dose period.

5.6 Site managers must ensure enough second dose appointments are available each day to accommodate individuals who have yet to book their second dose. This includes people in cohorts 1-9 who need to reschedule their second dose appointment within eight weeks of their first appointment, following updated guidance given on 15 May 2021.

5.7 For Pfizer-BioNTech clinics, site managers must ensure that 20 second dose appointments are available each day. Smaller sites may offer lower numbers depending on their vaccine allocation and capacity. Second dose capacity for AstraZeneca clinics will be based on regional agreement.

6. Appointment Management Strategies

6.1 Site managers have access to appointment details, can cancel booked appointments, and view and print the calendar.

6.2 It is advisable to print out site appointments at the start of the working day to ensure backup in case of lost internet connectivity. Note that appointments a day in advance may be booked up until midnight.

6.3 Two methods can be used to access the appointments list for each day: printing appointments via the calendar, or using the Unit Appointments Listing report.

7. Appointment Cancellation

7.1 To cancel an appointment, individuals can use the NBS online function or the call center they used for booking. However, individuals cannot cancel appointments on the same day. In contrast, vaccination sites have the authority to cancel appointments on the same day.

7.2 If a vaccination site cancels an appointment, its manager must log onto the system and complete the cancellation. For more information about the cancellation process, please click here.

7.3 If the system has the user's email address or mobile number, the user will instantly receive a notification about the cancellation. If only a landline number is available, the site staff will have to get in touch with the individual and suggest using the same method used previously to re-book the appointment.

7.4 If the system has no contact information, it's likely that the user will show up for the appointment. For more information, refer to the FAQ document on the Vaccine Booking Service.

7.5 Vaccination sites are not responsible for re-booking appointments for individuals whose appointments they canceled. Individuals must book themselves through the NHS website or by calling 119.

7.6 It's presently not possible to cancel appointments in bulk.

8. Did-Not-Attends (DNAs)

8.1 If an individual misses an appointment, they must re-book their appointment the day after their missed appointment.

8.2 Individuals who miss their appointment and are not checked-in will be recorded as a ‘DNA’ on the Unit Appointments List report. Individuals can then rebook their appointment from the day after their missed appointment.

8.3 The Unit Appointments List report on Q-flow can help calculate the number of DNAs on any given day. If an appointment has not been checked in by 11:00pm, the status will automatically switch to ‘DNA’ by midnight. Data collection on the Unit Appointments List report necessitates a site to use the check-in app to mark the individuals who have attended.

8.4 Individuals marked as ‘DNA’ for their first appointment will not have their second appointment canceled automatically. This is because a ‘DNA’ notice on the NBS is insufficient evidence that an individual has not been vaccinated.

9. Check-In and Validation

9.1 To check-in individuals, arrival stewards will be using the 'check a vaccination appointment’ app. This app is available here and is accessible through a smart device. Stewards shall log in at the start of their shift and confirm the VC they are working at to access the appointment records for that day. The app contains instructions on the questions to ask and the information to enter.

9.2 The service user check-in process can be found here.

9.3 Some individuals may arrive for their appointment with a print-out of their selected appointments without confirming them on the NBS portal. As a result, they will not have the booking reference or an appointment recorded. These individuals are entitled to the vaccine and should be vaccinated. The NBS has been updated, and the requirement to confirm the appointment details has been eliminated.

9.4 Following individual appointment check-in, other check-in procedures may be in place to ensure everyone's safety and assist in assessing citizens before vaccination.

9.5 When an appointment is scheduled, its status becomes 'expected.'

9.6 Once the individual checks in through the check-in app, the status changes to 'waiting.'

9.7 After 11pm on the day the appointment was checked in, the waiting status automatically changes to 'completed.' Note that NBS only confirms the completion of the appointment and not the actual vaccination, so it is possible for someone to attend the appointment but not receive the vaccination if they do not provide consent.

9.8 If an individual fails to check-in, the appointment status automatically becomes 'no show' after 11pm on the day of the appointment.

9.9 The information collected through the check-in app, including attendance figures, is directly inputted to Foundry, eliminating the need for vaccination sites to provide such information in the SitReps.

10. Vaccinations for Non-NBS Appointments

10.1 Occasionally, a vaccination site may administer a vaccine to someone without an appointment on NBS. For example, this may include site volunteers, HSCWs, or caregivers. Such individuals should be advised to book their second dose through NBS or by calling 119.

10.2 If a vaccination site administers a vaccine to someone without an appointment on NBS, they do not need to create an appointment on the platform.

11. Health and Social Care Workers

11.1 Eligible frontline health and social care workers aged 18 and above can book through the self-declaration mode on NBS. Local systems must continue to ensure local provision for all eligible health and care workers.

11.2 As mentioned in the letter of 11 February, social care workers using the online or telephone service need to self-declare at the time of booking and present identification and written authorization during their appointment.

11.3 The NBS remains open for booking by unpaid carers who are eligible on the National Immunisation Management Service. Unpaid carers do not require an NHS number or registration with a GP to enroll for the vaccine, but they must provide an NHS number to book through NBS.

12. Report Generation

12.1 Site and regional managers can access a report displaying the number of appointments scheduled for each date range, providing efficient capacity management.

13. Vaccination Service Desk

13.1 In the event of system failure and inability to access Q-Flow or the check-in app, site personnel must enroll individuals manually and reconcile them by the end of the day.

13.2 ATOS operates a single point of contact Vaccination Service Desk for technical and data queries available via email or phone every day (including bank holidays).

14. Training

14.1 Site manager training sessions have been scheduled and will be relayed via the NBS Onboarding team.

14.2 A collaborative online workspace is available to all health and care personnel involved in the COVID vaccination program, providing detailed information related to the IT systems in use and future training sessions. If not already a user, one must sign-up for the Future NHS collaborative platform to access the workspace.

14.3 Visit the training calendar on the NHS Futures platform for information regarding upcoming training sessions or drop-ins.

14.4 Colleagues interested in the workspace can email [email protected] for an invite.